Benefits of Breastfeeding

Large, good quality, well controlled studies and good quality systematic reviews demonstrate that in developed countries, not breastfeeding significantly increases the risk of gastro-intestinal disease (1, 2), lower respiratory tract infection (1,2), and sudden infant death syndrome for infants (1); necrotising enterocolitis for preterm infants (3); childhood cancers (4) and maternal breast cancer (4). The epidemiological evidence supported by related physiological and immunological evidence suggests that not breastfeeding is likely to increase the risks of illnesses including Type 2 diabetes (5), coeliac disease (6), otitis media (1), obesity (7), and indicators of future cardiac disease (8) in the child, and ovarian cancer in the mother (1). Increasingly strong evidence indicates a significant impact on cognitive and behavioural outcomes for the child (9). No other health behaviour has such a broad spectrum and long-lasting impact on population health, with the potential to improve life chances, a key policy priority (10), as well as survival and health.

The fundamental importance of infant feeding to health and development has been recognised in national and international policy recommendations and guidance. The World Health Organisation (WHO) recommends that babies are exclusively breastfed until six months (11), as do all four UK Departments of Health. Despite this policy position, breastfeeding rates in the UK have remained low for several decades. Virtually no babies are exclusively breastfed to the recommended six months, and only 34% are breastfed at all at six weeks after birth. These rates are in contrast to other developed countries (Norway, Sweden) where the vast majority of women breastfeed for at least two months.

Health and development outcomes related to not breastfeeding are associated with a substantial cost burden. A recent US study found that if 90% of mothers complied with breastfeeding recommendations, then 900+ deaths would be prevented and $13 billion saved annually from the US health budget (12). A UNICEF UK study examining the cost burden of not breastfeeding has recently been published and the findings will be used to inform this study.

Not breastfeeding is both an outcome and a cause of health and social inequality. It is an outcome of inequality because (i) low income families have the lowest rates of breastfeeding; (ii) there is a marked inter-generational effect that perpetuates these low rates (13) (iii); the long-term health and development of the child is affected by whether or not she/he is breastfed and (iv) the social patterning of infant feeding results in the greatest burden of ill health and adverse effects falling on the poorest families. At the same time, breastfeeding provides a solution to this longstanding problem, and is in itself an intervention to tackle inequalities in health; a child from a low income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula fed (14). In Sheffield, neighbourhood level six week breast feeding rates are negatively associated with Index of Multiple Deprivation with a correlation of -0.4 (95% CI -0.20 to -0.56).

Relatively little is known about the costs and health benefits of breastfeeding interventions in the general population and even less is known about the costs and outcomes within sub-populations stratified by socioeconomic status. To date, economic models of breastfeeding interventions have been small scale (15). Our study will be informed by the results of ongoing UNICEF UK cost analysis of breastfeeding outcomes (led by Mary Renfrew & Julia Fox-Rushby), which is available to download at the right-hand link.